Involving the health care system in domestic violence: what women want

Youth is Prized in Medicine, Old Age is Valued in Law: Analysis of Media Narratives Over 200 Years

BACKGROUND

This is the first study to explore how age has influenced depictions of doctors and lawyers in the media over the course of 210 years, from 1810 to 2019. The media represents a significant platform for examining age stereotypes and possesses tremendous power to shape public opinion. Insights could be used to improve depictions of older professionals in the media.

OBJECTIVE

This study aims to understand how age shapes the portrayals of doctors and lawyers. Specifically, it compares the difference in sentiments toward younger and older doctors as well as younger and older lawyers in the media over 210 years.

METHODS

Leveraging a 600-million-word corpus of American media publications spanning 210 years, we compiled top descriptors (N=478,452) of nouns related to youth × occupation (eg, younger doctor or physician) and old age × occupation (eg, older lawyer or attorney). These descriptors were selected using well-established criteria including co-occurrence frequency and context relevance, and were rated on a Likert scale from 1 (very negative) to 5 (very positive). Sentiment scores were generated for "doctor/physician," "young(er) doctor/physician," "old(er) doctor/physician," "lawyer/attorney," "young(er) lawyer/attorney," and "old(er) lawyer/attorney." The scores were calculated per decade for 21 decades from 1810 to 2019. Topic modeling was conducted on the descriptors of each occupation in both the 1800s and 1900s using latent Dirichlet allocation.

RESULTS

As hypothesized, the media placed a premium on youth in the medical profession, with portrayals of younger doctors becoming 10% more positive over 210 years, and those of older doctors becoming 1.4% more negative. Meanwhile, a premium was placed on old age in law. Positive portrayals of older lawyers increased by 22.6% over time, while those of younger lawyers experienced a 4.3% decrease. In the 1800s, narratives on younger doctors revolved around their participation in rural health care. In the 1900s, the focus shifted to their mastery of new medical technologies. There was no marked change in narratives surrounding older doctors from the 1800s to the 1900s, though less attention was paid to their skills in the 1900s. Narratives on younger lawyers in the 1800s referenced their limited experience. In the 1900s, there was more focus on courtroom affairs. In both the 1800s and 1900s, narratives on older lawyers emphasized their prestige, especially in the 1900s.

CONCLUSIONS

Depending on the occupation, one's age may either be seen as an asset or a liability. Efforts must be expended to ensure that older professionals are recognized for their wealth of knowledge and skills. Failing to capitalize on the merits of an older workforce could ultimately be a grave disservice not only to older adults but to society in general.

A Systematic Review of Culturally Competent Family Violence Responses to Women in Primary Care

Existing culturally competent models of care and guidelines are directing the responses of healthcare providers to culturally diverse populations. However, there is a lack of research into how or if these models and guidelines can be translated into the primary care context of family violence. This systematic review aimed to synthesise published evidence to explore the components of culturally competent primary care response for women experiencing family violence. We define family violence as any form of abuse perpetrated against a woman either by her intimate partner or the partner's family member. We included English language peer-reviewed articles and grey literature items that explored interactions between culturally diverse women experiencing family violence and their primary care clinicians. We refer women of migrant and refugee backgrounds, Indigenous women and women of ethnic minorities collectively as culturally diverse women. We searched eight electronic databases and websites of Australia-based relevant organisations. Following a critical interpretive synthesis of 28 eligible peer-reviewed articles and 16 grey literature items, we generated 11 components of culturally competent family violence related primary care. In the discussion section, we interpreted our findings using an ecological framework to develop a model of care that provides insights into how components at the primary care practice level should coordinate with components at the primary care provider level to enable efficient support to these women experiencing family violence. The review findings are applicable beyond the family violence primary care context.

Violence against Women by Addicted Husbands in Iraq

Objective: Despite that women are becoming active participants and protagonists of the development social, economic, and political process, they still suffer from the distress of violence, and this problem still spread worldwide. Domestic violence against women is studied in the general population, but the violence against women with addicted spouses was little highlighted especially in Iraq, and this study aimed to reveal the rate of violence and to clarify the different types of violence against wives of addicted husbands. Methods: This comparative study was carried in Ibn Rushud psychiatric training hospital in Baghdad, Iraq This study has been done during the time extended from10th April to 20thof December 2020, and conducted on 400 married women,200 of them were women with addicted husbands, and200were women with no addicted husband. The inclusion criteria were married women living with her husband, and those women who voluntarily gave consent were included. Divorced widows and pregnant women are excluded. The questionnaire used was valid and reliable and appropriate to our society's culture furthermore it was used in a similar study done in the neighboring country. Data analysis was performed using SPSS. Descriptive statistics and chi-square, Mann-Whitney U, and Kruskal–Wallis tests, odds ratio (OR), and Kendall's correlation coefficient were used to analyze the data. The overall mean score of violence was 70.47 ± 14.32 for the women with addicted husbands and 42.01 ± 7.50 for women with non-addicted spouses (P < 0.001). The mean score of psychological violence was 40.03 ± 5.03 in women with addicted spouses and 23.40 ± 4.26 in those with non-addicted husbands (P < 0.001). Furthermore, the mean score of physical violence was 23.71 ± 6.24 in women with addicted spouses and 15.50 ±3.76 in those with non-addicted husbands (P < 0.001). Moreover, the mean scores of sexual violence were 3.21 ± 2.11 and 2.92 ± 0.25 in women with and without addicted spouses, respectively (P < 0.001). Finally, the mean scores of financial violence were 2.10±0.94and 1.10 ± 0.23 for women with and without an addicted husband, respectively (P<0.001). Result: The finding confirms the conclusion of other studies and reveals that the overall rate of violence was significantly higher among women with addicted spouses and especially if the spouse abused more than one type of substance.

Physical morbidity and psychological and social comorbidities at five stages during pregnancy and after childbirth: a multicountry cross-sectional survey

OBJECTIVE

Maternal morbidity affects millions of women, the burden of which is highest in low resource settings. We sought to explore when this ill-health occurs and is most significant.

SETTINGS

A descriptive observational cross-sectional study at primary and secondary-level healthcare facilities in India, Pakistan, Kenya and Malawi.

PARTICIPANTS

Women attending for routine antenatal care, childbirth or postnatal care at the study healthcare facilities.

PRIMARY AND SECONDARY OUTCOMES

Physical morbidity (infectious, medical, obstetrical), psychological and social comorbidity were assessed at five stages: first half of pregnancy (≤20 weeks), second half of pregnancy (>20 weeks), at birth (within 24 hours of childbirth), early postnatal (day 1-7) and late postnatal (week 2-12).

RESULTS

11 454 women were assessed: India (2099), Malawi (2923), Kenya (3145) and Pakistan (3287) with similar numbers assessed at each of the five assessment stages in each country. Infectious morbidity and anaemia are highest in the early postnatal stage (26.1% and 53.6%, respectively). For HIV, malaria and syphilis combined, prevalence was highest in the first half of pregnancy (10.0%). Hypertension, pre-eclampsia and urinary incontinence are most common in the second half of pregnancy (4.6%, 2.1% and 6.6%). Psychological (depression, thoughts of self-harm) and social morbidity (domestic violence, substance misuse) are significant at each stage but most commonly reported in the second half of pregnancy (26.4%, 17.6%, 40.3% and 5.9% respectively). Of all women assessed, maternal morbidity was highest in the second half of pregnancy (81.7%), then the early postnatal stage (80.5%). Across the four countries, maternal morbidity was highest in the second half of pregnancy in Kenya (73.8%) and Malawi (73.8%), and in the early postnatal stage in Pakistan (92.2%) and India (87.5%).

CONCLUSIONS

Women have significant maternal morbidity across all stages of the continuum of pregnancy and childbirth, and especially in the second half of pregnancy and after childbirth.

Barriers to help-seeking from healthcare professionals amongst women who experience domestic violence - a qualitative study in Sri Lanka

BACKGROUND

Domestic violence (DV) is a major global public health problem which is associated with significant adverse consequences. Although Sri Lankan women who experience DV receive treatment from healthcare professionals (HCPs) for DV related physical and psychological problems, disclosure of DV within health services is quite low. This study explored barriers to disclosure of DV to HCPs among Sri Lankan women who experience DV.

METHOD

This qualitative study took place in the Central Province of Sri Lanka. Twenty women who had experienced DV were recruited from Gender Based Violence Centers (Mithuru Piyasa Centers) and a toxicology unit of the two selected hospitals. Participants were purposefully selected using maximum variation sampling technique. In-depth interviews were conducted until data saturation was reached. Interviews were recorded, and analyzed using thematic analysis.

RESULTS

Survivor related barriers to help seeking included women's lack of knowledge and perceptions about the role of HCPs, lack of confidence in HCPs, fear of repercussions, personal attitudes towards DV, and their love and loyalty towards the perpetrator. Women preferred it if HCPs initiated discussions about DV, and they valued it when HCPs could be confidential and protect their privacy, and give enough time for DV related issues during consultations. A perpetrator related barrier was the controlling behavior of the perpetrator. Social stigma and social and cultural norms about the role of women emerged as the socio-cultural constraints to disclosure.

CONCLUSIONS

Barriers to help seeking for DV from HCPs exist at individual, healthcare level, and societal level. Community programs are needed to increase women's access to healthcare services and interventions should be implemented to develop effective, preventive, and supportive strategies at the healthcare system level.

How to Facilitate Disclosure of Violence while Delivering Perinatal Care: The Experience of Survivors and Healthcare Providers

Gender-based Violence (GBV) during the perinatal period is a serious concern as it is associated with many adverse outcomes for both the mother and the baby. It is well known that violence is under-reported. Thus, official statistics (both police reports and survey data) underestimate the prevalence of violence in general and during the perinatal period specifically. In this study conducted in Canada, we sought to explore the barriers to and facilitators of women disclosing their experiences of GBV within healthcare services to safely facilitate more disclosure in the future and reduce the harms that arise from GBV. We used thematic analysis to analyze in-depth interviews with 16 healthcare providers (nurses, midwives and physicians) and 12 survivors of GBV. The data reflect three main themes: "raising awareness of gender-based violence", "creating a shift in the healthcare system's approach toward gender-based violence" and "providing support for survivors and care providers." Our findings suggest that the healthcare system should increase its investments in raising awareness regarding GBV, training healthcare providers to respond appropriately, and building trust between survivors and healthcare providers. Healthcare providers need to be aware of their role and responsibility regarding identifying GBV as well as how to support survivors who talk about violence. Expanding a relationship-based approach in the care system and providing support for both survivors and health care providers would likely lead to more disclosures.

An integrative review of community nurse-led interventions to identify and respond to domestic abuse in the postnatal period

AIM

To critically review community nurse-led domestic abuse interventions aimed at identifying and responding to domestic abuse in the postnatal period.

BACKGROUND

Domestic abuse is a global problem resulting in dire consequences for women and children. Public Health Nurses (PHNs) are ideally placed to give women the opportunity to disclose in a safe and confidential manner; however, community settings present complex challenges.

DESIGN

An integrative review and narrative summary.

DATA SOURCES

Five electronic databases: CINAHL, MEDLINE, PsycINFO, EMBASE and Scopus, and peer-reviewed journals were searched for research papers published between 01 January 2005 and 01 March 2019. Fifteen papers met the inclusion criteria.

REVIEW METHODS

An integrative review where qualitative and quantitative data were extracted. Following quality appraisal, data were collated, analysed and themes were identified.

RESULTS

Quantitative outcomes from short-term interventions include an increase in routine enquiry, documentation of alone status and safety planning, however, referrals remained low. There was a reduction in victimization seen in intensive home visiting interventions. One study reported potential harm to mothers experiencing domestic abuse prior to the intervention. Thematic analysis generated three themes: (1) benefits to women and nurses, (2) approaches to domestic abuse identification and response and (3) implementation of community nurse-led interventions.

CONCLUSION

Community nurse-led domestic abuse interventions have shown to have positive outcomes for women, provided the appropriate supports are in place such as: interagency training; guidelines, referral pathways and safety protocols; collaborative working with domestic abuse services and organizational support.

IMPACT

Professionals such as PHNs are challenged to respond appropriately and compassionately to domestic abuse disclosures, while ensuring the safety of women and children is central to service delivery. This integrative review will inform further development, implementation and the sustainability of community nurse-led domestic abuse initiatives worldwide.

Knowledge, attitudes and practices of health care providers trained in responding to violence against women: a pre- and post-intervention study

BACKGROUND

Violence against women is a serious public health concern, and is highly prevalent globally, including in India. Health-care providers [HCPs] can play an important role in addressing and reducing negative consequences of violence against women. We implemented a pre-post intervention study of HCP training in three tertiary care facilities in Maharashtra, India.

METHODS

The study used a pre-post intervention design with assessment of HCPs' (n = 201) knowledge, attitudes, perceived preparedness and practice at three time points: before training, after training and at 6 months follow- up.

RESULTS

Total median score of knowledge about common signs and symptoms of violence (8.89 vs, 10.00), attitudes towards acceptability of violence (9.05 vs. 10.00), individual (6.74 vs. 10.00) and system level preparedness (6.11 vs. 8.14) improved from pre to post- training. The generalized estimating equation [GEE] model, adjusted for age, sex, site and department, showed an improvement in knowledge, attitudes and preparedness post- training. The change from pre to 6 months follow- up was not significant for attitude.

CONCLUSIONS

This package of interventions, including training of HCPs, improved HCPs' knowledge, attitudes and practices, yet changes in attitudes and preparedness did not sustain over time. This study indicates feasibility and positive influence of a multi-component intervention to improve HCP readiness to respond to violence against women in a low-resource setting. Future phases of intervention development include adapting this intervention package for primary and secondary health facilities in this context, and future research should assess these interventions using a rigorous experimental design. Finally, these results can be used to advocate for multi-layered, systems-based approaches to strengthening health response to violence against women.

Validation of the French Women Abuse Screening Tool to routinely identify intimate partner violence

BACKGROUND

Health care professionals strongly underestimate the prevalence of intimate partner violence (IPV), and a few of them think that they screen and refer victims appropriately for assistance. The aim of this study was to cross-culturally validate a French version of the Woman Abuse Screening Tool (WAST).

METHODS

A multicenter case-control study was performed in the forensic medicine unit of the University Hospital and two offices of the women's rights association in France. Abused and non-abused women self-completed the WAST and a questionnaire assessing their level of comfort in responding to the WAST during the study and during a hypothetical consultation with a physician in primary care. We analyzed the psychometric properties and screening performance of the WAST.

RESULTS

Respondent acceptability was very good, with response rates exceeding 95%. The WAST had a good internal consistency (Cronbach α coefficient = 0.95). Its screening performance with a cut-off score of 5 was excellent: area under the ROC curve was 0.99, sensitivity 97.7%, specificity 97.1%, positive predictive value 97.2% and negative predictive value 97.7%. The levels of comfort were significantly lower among abused compared with non-abused women. Both groups of women were more comfortable answering the WAST during the study than in a hypothetical consultation.

CONCLUSION

The French version of the WAST was found to be a well-accepted and valid screening tool for routine use in IPV. It may help health care professionals to detect women experiencing abuse early and to refer them more quickly to specific assistance.

Intimate partner violence among pregnant women reporting to the emergency department: findings from a nationwide sample

OBJECTIVE

Intimate partner violence (IPV) describes physical violence, sexual violence, stalking, or psychological harm by a current or former partner or spouse. During pregnancy, IPV has substantial negative implications for maternal and child health. The aim of the present study was to better understand the prevalence and sociodemographic and psychiatric correlates of IPV among pregnant females in the emergency department (ED).

METHODS

Using the 2016 Nationwide Emergency Department Sample (NEDS), logistic regression was employed to examine the relationship between IPV during pregnancy, sociodemographic factors, substance abuse and mental health disorders.

RESULTS

Bivariate analyses indicated that approximately 0.06% of pregnant women who visited EDs in 2016 were coded as experiencing abuse by a spouse or partner. Pregnant women abused by a spouse or partner were more likely to have a diagnosis of each of the disorders coded as complicating pregnancy, childbirth and the puerperium examined in this study, including alcohol use (0.77%, aOR 8.38, 95% CI 2.80 to 29.50), drug use (2.26%, aOR 3.49, 95% CI 1.60 to 6.15), tobacco use (11.05%, aOR 1.90, 95% CI 1.34 to 2.54) and general mental disorders (4.13%, aOR 2.64, 95% CI 1.60 to 4.79).

CONCLUSION

Screening for IPV in EDs, especially among at-risk women identified in this study, may lead to referrals and coordination of care that could reduce the violence and improve maternal and child health outcomes.

Violence towards women and their decisions to take action: A complex systems approach

Intimate partner violence (IPV) is a blight on society. Our traditional understanding suggests that interventions should be straightforward, leading to predictable positive results. However, these assumptions do not reflect the reality of IPV, which continues to frustrate physicians. While IPV research has thoroughly described the developmental risks and impacts of IPV, the violent incident itself remains largely unstudied and poorly understood. Although this lack of research may partially explain physician frustration and the limitations of our interventions, the greater problem may be our reliance upon the wrong paradigm in guiding our understanding. Complexity science says that systems are globally understandable, but not completely knowable. Our hypothesis is that IPV needs to be viewed as a complex adaptive system if we are to understand the phenomenon, identify expectations and appropriately intervene. When viewed through the lens of complexity science, IPV becomes less knowable and predictable, suggesting that interventionists should expect variable response. Research has indeed demonstrated that partner violence is a complex phenomenon with multiple, interdependent factors and a nonlinear trajectory. This nonlinearity/unpredictability can impact outcomes in IPV, often more so than the frequency or severity of the violence. Similarly, women's decision-making concerning the violence is also a nonlinear process dependent upon multiple factors and catastrophic influences. Once recognized, complexity science offers a novel approach to explain IPV's obfuscation and resistance to predictable change. Using the tempered expectations of a systems lens, the violent interdependencies can be clarified, the obscure causes of events can be visualized, and the temporal irregularities can be mapped. Not only can the disruptive tipping points, system feedforward propagations, powerful attractors and discontinuities compromise reasoned intervention, but these same factors, if understood, can be harnessed to foster and magnify circumstances that enable positive change.

Barriers to women's disclosure of domestic violence in health services in Palestine: qualitative interview-based study

Background

Domestic violence (DV) damages health and requires a global public health response and engagement of clinical services. Recent surveys show that 27% of married Palestinian women experienced some form of violence from their husbands over a 12 months' period, but only 5% had sought formal help, and rarely from health services. Across the globe, barriers to disclosure of DV have been recorded, including self-blame, fear of the consequences and lack of knowledge of services. This is the first qualitative study to address barriers to disclosure within health services for Palestinian women.

Methods

In-depth interviews were carried out with 20 women who had experienced DV. They were recruited from a non-governmental organisation offering social and legal support. Interviews were recorded, transcribed and translated into English and the data were analysed thematically.

Results

Women encountered barriers at individual, health care service and societal levels. Lack of knowledge of available services, concern about the health care primary focus on physical issues, lack of privacy in health consultations, lack of trust in confidentiality, fear of being labelled ‘mentally ill’ and losing access to their children were all highlighted. Women wished for health professionals to take the initiative in enquiring about DV. Wider issues concerned women’s social and economic dependency on their husbands which led to fears about transgressing social and cultural norms by speaking out. Women feared being blamed and ostracised by family members and others, or experiencing an escalation of violence.

Conclusions

Palestinian women’s agency to be proactive in help-seeking for DV is clearly limited. Our findings can inform training of health professionals in Palestine to address these barriers, to increase awareness of the link between DV and many common presentations such as depression, to ask sensitively about DV in private, reassure women about confidentiality, and increase awareness among women of the role that health services can play in DV.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09907-8.

Nurse Training in Gender-Based Violence Using Simulated Nursing Video Consultations during the COVID-19 Pandemic: A Qualitative Study

Gender-based violence (GBV) is a serious global public health problem that becomes aggravated during public health emergencies that involve quarantine measures. It is important to train nursing students on GBV, especially in vulnerable situations, such as the current COVID-19 pandemic. The purpose of our study is to explore the perceptions of third-year nursing students about simulated nursing video consultations for providing assistance to potential cases of GBV victims using a high-fidelity clinical simulation methodology. After all of the simulated scenarios were completed, 48 scripted interviews were carried out following a guide composed of four open-ended questions to facilitate in-depth discussion. A descriptive qualitative study based on the interpretative paradigm was conducted. The nursing students indicated that they improved their knowledge on GBV victim management (mainly their awareness of the problem, recognition of the role of nursing professionals, and performance of non-technical skills), although they also mentioned the need for continuous training (particularly in socio-emotional skills, interview techniques, a holistic nursing care approach, and not presupposing). This innovative high-fidelity simulation methodology allows nursing students to improve their awareness of the GBV problem, acquire a realistic view about their role in addressing GBV, and build their non-technical skills (such as active listening, communication skills, empathy, and generating confidence) required to adequately care for victims of GBV.

Healthcare Worker Experience and the Challenges in Screening for Intimate Partner Violence Among Women Who Use Antiretroviral Therapy and Other Health Services in Wolaita Zone, Ethiopia: A Phenomenological Study

Background

Intimate partner violence is a crime against humanity. This study aimed to explore the experiences and challenges in screening for intimate partner violence among women who use antiretroviral therapy and other health services in Wolaita Zone in Ethiopia.

Methods

A descriptive phenomenological qualitative study design was used, and 16 in-depth interviews were conducted with healthcare workers from 19 health facilities who were providing healthcare services in Wolaita Zone. We selected participants purposively until data saturation was reached. Colaizzi’s descriptive phenomenological method was used for the data analysis, and the Open Code software was used to assist with the data coding. We maintained the scientific rigour of credibility, transferability, dependability, and confirmability.

Results

Analysis of the study data identified the following five themes: type of IPV identified by HCWs among women, provider-related barriers, healthcare system barriers, patient-level barriers, and providers’ recommendations for improvements. Issues that emerged from these findings were a gap in medico-legal report provision, absence of a separate record-keeping for IPV cases, lack of client follow-up, absence of routine assessment of violence for women who have injuries, and lack of specific coordination with an external organisation. Moreover, the absence of staff training, weak referral systems, and a shortage of necessary medical equipment challenged IPV screening.

Conclusion

This study has shown that there are healthcare provider and health system challenges relating to screening clients for intimate partner violence in Wolaita Zone. Provision of separate record-keeping of intimate partner violence cases in the healthcare facilities, standardising the medico-legal reporting system, improving women’s access to education, and executing more gender-equitable policies, are needed. Moreover, the inclusion of intimate partner violence-specific policy frameworks in national legislation is necessary.

Women's Experiences of Being Screened for Intimate Partner Violence in the Health Care Setting

OBJECTIVE

To qualitatively describe experiences of survivors of intimate partner violence (IPV) in being screened for IPV and to identify opportunities to improve screening and response by health care providers.

DESIGN

Qualitative descriptive study.

SETTING/LOCAL PROBLEM

Although it is recommended that nurses and other health care providers screen for IPV, a local needs assessment of IPV screening among health care practices in Houston, Texas, showed inconsistencies in IPV screening practices, a lack of understanding on how to screen for IPV, and low referral rates to IPV agencies.

PARTICIPANTS

Seventeen survivors of IPV from three agencies that provide services to survivors of IPV.

INTERVENTION/MEASUREMENTS

Three focus groups were conducted, and notes were coded and analyzed for content and themes using open coding from the observed data. The constant comparative method was used for the analysis.

RESULTS

Four themes emerged from the focus group data. The first three themes address concepts and dynamics of IPV that affect IPV screening and disclosure of abuse. The final theme addresses screening for IPV in health care settings.

CONCLUSION

Many survivors reported that they were not screened for IPV by health care professionals, and those who were screened were not screened effectively. Compassionate care is needed in these situations, and nurses and other health care providers should be aware that the responses of IPV survivors are dynamic and may change over time.

The Effect of Tidal Model-Based Psychiatric Nursing Approach on the Resilience of Women Survivors of Violence

This study examined the effect of a psychiatric nursing approach based on the Tidal Model. The outcome variable was resilience in women survivors of violence. The experimental and descriptive study was conducted with a control group and a pretest post-test procedure. The research was carried out with 13 women in the intervention and 14 women in the control group. Resilience Scale for Adults Turkish Version (RSA) was used. Seven one to one sessions were performed with the intervention group. Inter-group comparison of pre- and post-test variation showed significant variations in favor of the intervention group in perception of the future and RSA scale total scores. Consequently the resilience of the intervention group increased, and they had a more positive, target-focused view of the future.

Violence against Women in a Slum Area in Helwan, Cairo, Egypt: A Community Based Survey

Background: Violence against women (VAW) is a major global public health problem with serious consequences. We aimed to estimate the prevalence of VAW aged 18-45 yr in a slum area in Helwan, Cairo, to assess their knowledge and perspective regarding VAW, and to assess their help-seeking practice in response to violence.

Study design: Cross-sectional design.

Methods: This community based survey was carried out among 657 women in a slum area in Helwan, Cairo, Egypt in 2018. Data about the women’s knowledge about VAW, exposure to different forms of violence and their frequency, women’s perspective towards violence, and their healthcare-seeking behavior on exposure to violence were collected using an interviewing questionnaire.

Results: The prevalence of exposure to at least one type of intimate partner violence (IPV) was 59.1% with psychological violence ranking 1^st followed by physical violence. Most women exposed to IPV reported that they have never asked for healthcare upon exposure to violence. One third had good knowledge. Most had favorable perspective against VAW.

Conclusion: Most women suffered some kind of violence. They, however, did not seek help most of the time.

Violence against women in Primary Health Care: Potentialities and limitations to identification

Objective

To determine the potential and limitations of Primary Health Care professionals to identify situations of violence against women.

Location

A municipality of Rio Grande do Sul, Brazil.

Design

Descriptive and exploratory study with a qualitative approach.

Participants

Twenty-one health professionals of three Family Health Strategy units, as well as one Basic Health Unit. The inclusion criterion consisted of being a health worker in these services. The exclusion criterion was to be absent from work by any kind type license during the period of data production.

Method

The technique used to produce data was individual, semi-structured, interviews in order to collect sociodemographic data and the monitoring by professionals related to the potentials and limitations to identify violence situations. The data collection was suspended based on the saturation criterion. The data were systematized and analyzed by the content analysis technique, according to the analytical categories of health care network and gender.

Results

The potential to identify themes were: professional experience, receptive atmosphere, bonding, and listening to the reports of women, children and/or neighbors and observing their behavior; to identify the lesions; prenatal consultations; and home visits. As to the limitations: silence, denial/non-recognition of violence, lack of complaints by women; fear and guilt; flaws and unpreparedness of the health team; and fear due to the presence of aggressor.

Conclusions

It is urgent to recognize the potential of Primary Care and to promote the qualification of professionals in order to identify the situation among visible and invisible complaints, leading to the confrontation of violence.

Digital Education of Health Professionals on the Management of Domestic Violence: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background

The World Health Organization states that 35% of women experience domestic violence at least once during their lifetimes. However, approximately 80% of health professionals have never received any training on management of this major public health concern.

Objective

The objective of this study was to evaluate the effectiveness of health professions digital education on domestic violence compared to that of traditional ways or no intervention.

Methods

Seven electronic databases were searched for randomized controlled trials from January 1990 to August 2017. The Cochrane Handbook guideline was followed, and studies reporting the use of digital education interventions to educate health professionals on domestic violence management were included.

Results

Six studies with 631 participants met our inclusion criteria. Meta-analysis of 5 studies showed that as compared to control conditions, digital education may improve knowledge (510 participants and 5 studies; standardized mean difference [SMD] 0.67, 95% CI 0.38-0.95; I²=59%; low certainty evidence), attitudes (339 participants and 3 studies; SMD 0.67, 95% CI 0.25-1.09; I²=68%; low certainty evidence), and self-efficacy (174 participants and 3 studies; SMD 0.47, 95% CI 0.16-0.77; I²=0%; moderate certainty evidence).

Conclusions

Evidence of the effectiveness of digital education on health professionals’ understanding of domestic violence is promising. However, the certainty of the evidence is predominantly low and merits further research. Given the opportunity of scaled transformative digital education, both further research and implementation within an evaluative context should be prioritized.

Health care providers' perceptions and practices of screening for domestic violence in Upper Egypt

OBJECTIVES

To explore the attitude of health care providers about screening for and dealing with domestic violence in the health care setting and to assess the physicians screening behavior.

METHODS

We surveyed physicians and nurses working in different departments of Assiut University Hospital using a self-administered questionnaire. Two focus group discussions with physicians and nurses were also conducted.

RESULTS

44.3% and 46.5% of physicians and nurses mentioned time constraints as a barrier for DV screening. Physicians believed that it is not important to screen for DV because it is a socially accepted problem and because of the unavailability of the necessary referrals to help victims (30.2% and 20.0%, respectively). The unsuitability of the outpatient clinics to screen for DV was also mentioned by 65.6% and 75.5% of physicians and nurses respectively. Only 36.7% of physicians perceived having the communication skills to facilitate disclosure of DV exposure. Regarding practice, only 35.0% of physicians have screened for DV in the three months preceding data collection. Urban residence, perception of the negative health consequence of DV exposure and perception of the physicians to have the required communication skills predicted positive attitude towards DV screening, while feeling distressed to discuss exposure to DV was associated with negative physicians' attitude.

CONCLUSION

In-service training of health care providers to identify and manage victims of DV and establishing supportive system would have great implications for reducing the physical and mental negative consequences of DV exposure.

Correction to: PTSD and gender: could gender differences in war trauma types, symptom clusters and risk factors predict gender differences in PTSD prevalence?

AbstractThe female-male ratio in the prevalence of post-traumatic stress disorder (PTSD) is approximately 2:1. Gender differences in experienced trauma types, PTSD symptom clusters, and PTSD risk factors are unclear. We aimed to address this gap using a cross-sectional design. A sample of 991 civilians (522 women, 469 men) from South Lebanon was randomly selected in 2007, after the 2006 war. Trauma types were grouped into disaster and accident, loss, chronic disease, non-malignant disease, and violence. PTSD symptom clusters involved re-experiencing, avoidance, negative cognitions and mood, and arousal. These were assessed using parts I and IVof the Arabic version of the Harvard Trauma Questionnaire (HTQ). Risk factors were assessed using data from a social support and life events questionnaire in multiple regression models. Females were twice as likely as males to score above PTSD threshold (24.3 vs. 10.4%, p ˂ 0.001). Total scores on all trauma types were similar across genders. Females scored higher on all symptom clusters (p < 0.001). Social support, social life events, witnessed traumas, and domestic violence significantly were associated with PTSD in both genders. Social support, social life events, witnessed traumas and domestic violence were significantly associated with PTSD in both genders. Conversely, gender difference in experienced traumas was not statistically significant. These findings accentuate the need to re-consider the role of gender in the assessment and treatment of PTSD.

PTSD and gender: could gender differences in war trauma types, symptom clusters and risk factors predict gender differences in PTSD prevalence?

The female-male ratio in the prevalence of post-traumatic stress disorder (PTSD) is approximately 2:1. Gender differences in experienced trauma types, PTSD symptom clusters, and PTSD risk factors are unclear. We aimed to address this gap using a cross-sectional design. A sample of 991 civilians (522 women, 469 men) from South Lebanon was randomly selected in 2007, after the 2006 war. Trauma types were grouped into disaster and accident, loss, chronic disease, non-malignant disease, and violence. PTSD symptom clusters involved re-experiencing, avoidance, negative cognitions and mood, and arousal. These were assessed using parts I and IV of the Arabic version of the Harvard Trauma Questionnaire (HTQ). Risk factors were assessed using data from a social support and life events questionnaire in multiple regression models. Females were twice as likely as males to score above PTSD threshold (24.3 vs. 10.4%, p ˂ 0.001). Total scores on all trauma types were similar across genders. Females scored higher on all symptom clusters (p < 0.001). Social support, social life events, witnessed traumas, and domestic violence significantly were associated with PTSD in both genders. Social support, social life events, witnessed traumas and domestic violence were significantly associated with PTSD in both genders. Conversely, gender difference in experienced traumas was not statistically significant. These findings accentuate the need to re-consider the role of gender in the assessment and treatment of PTSD.

Nurse education and understanding related to domestic violence and abuse against women: An integrative review of the literature

AIM

The aim of this study was to explore previous literature related to nurses understanding of Intimate partner violence (IPV) or domestic violence and abuse (DVA) against women and to identify the gaps in nursing education so as to use the findings as a baseline to inform potential intervention strategies, curriculum development and outline implications for future nursing practice.

DESIGN

An Integrative review of literature.

METHODS

Studies were extracted through a search of the electronic databases, such as Science direct, EBSCO host and PubMed, to identify relevant evidences published between January 2000-January 2017. "Joanna Briggs Institute (JBI) tool" was used to review primary research studies.

RESULTS

Seventeen empirical studies were analysed. Findings supported four themes including: educational and training experiences, identification of IPV/DVA, curriculum and communication skills of nurses. Continued efforts are further needed to highlight and address IPV/DVA in nursing education and training, to scale up nursing understanding to respond and identify IPV/DVA appropriately in a clinical environment.

Attitudes of Palestinians Toward Social Work Interventions in Cases of Wife Assault

The study examined the attitudes of Palestinian adults toward social work interventions in cases of husband-to-wife assault (HWA). A survey, using self-administered questionnaires and interviews, was conducted among a random sample of 624 adults from the Palestinian Authority. Results indicate higher levels of support for interventions aimed at helping the couple solve their problems than for interventions aimed at protecting the safety of battered women. However, this trend becomes reversed in cases of repeated and severe HWA. Greater support for interventions aimed at protecting the safety of battered women was found among women versus men and younger versus older adults, as well as among individuals with lower levels of justifying wife abuse and more egalitarian expectations of marriage.

Intimate partner violence discussions in the healthcare setting: A cross-sectional study

In 2013, the United States Preventive Services Task Force recommended routine intimate partner violence (IPV) screening for reproductive-age women. Given the increased attention paid to IPV on a national scale, and broader recognition of its social and physical implications, we sought to characterize the discussions resulting from routine IPV screening-specifically regarding provider response and patient perceptions. In a cross-sectional analysis, we implemented a survey to examine outcomes of IPV screening, including use of guideline-concordant discussion topics and interventions, as well as patient perception of the encounters. Women aged 18-65 with lifetime history of IPV and a past-year healthcare appointment were recruited from clinics and women's shelters in Pennsylvania. Data collection took place from May 2014-January 2015. Of 253 women, 39% were screened for IPV at a healthcare visit in the year prior to survey administration. Of women who were screened, guideline-concordant discussion topics were employed in 70% of encounters and guideline-concordant interventions were offered in 72% of encounters. 58% of women reported being "extremely" or "very satisfied," and 53% reported being "extremely" or "very comfortable" with IPV-related discussions. The low rate of screening in this population reiterates the importance of focusing efforts on educating providers on the importance of screening, promoting the availability of community resources, and developing systems-based practices that foster IPV screening, discussion, and referral following disclosure.

Provider Perspectives on Intimate Partner Violence in Bluefields, Nicaragua

BACKGROUND

Intimate partner violence represents a significant public health problem and a substantial human rights' issue for women and girls throughout the world. Design and Purpose: The purpose of this study was to answer these research questions: What are the current practices for addressing gender violence in the RACS? What do professionals consider to be the current strengths and gaps in policies related to gender violence in this region? By employing a qualitative descriptive approach (Sandelowski, 2000 ), researchers traveled from the US to Bluefields, Nicaragua, in 2012. The multidisciplinary team of two US nurses, a prosecutor, and a victim-witness advocate interviewed 18 key informants, police officers, advocates, and nurses, and observed court processes.

METHODS

Interviews were transcribed verbatim and analyzed in the language the interview was conducted in. Researchers coded data independently and identified emergent themes.

FINDINGS

Informants described the complexity of the nature and dynamics of gender violence, strongly informed by Nicaragua's fairly progressive laws. The participants described holistic, fully integrated services as the intended functioning of the system. These services were often thwarted by gaps-fragmentation and lack of resources-and were additionally hampered by substantial individual and structural economical obstacles.

"Keeping family matters behind closed doors": healthcare providers' perceptions and experiences of identifying and managing domestic violence during and after pregnancy

BACKGROUND

Violence against women is an international public health concern and a violation of women's rights. Domestic violence can first occur, and increase in frequency and severity, during and after pregnancy. Healthcare providers have the potential to identify and support women who experience domestic violence. We sought to investigate the knowledge and perceptions of domestic violence among doctors who provide routine antenatal and postnatal care at healthcare facilities in Pakistan. In addition, we explored possible management options from policy makers, and enabling factors of and barriers to the routine screening of domestic violence.

METHODS

Semi-structured key informant interviews were conducted with doctors (n = 25) working in public and private hospitals and with officials involved in domestic violence policy development (n = 5) in Islamabad, Pakistan. Transcribed interviews were coded and codes grouped into categories. Thematic framework analysis was undertaken to identify emerging themes.

RESULTS

Most doctors have a good awareness of domestic violence and a desire to help women who report domestic violence during and after pregnancy. Enabling factors included doctors' ability to build rapport and trust with women and their suggestion that further education of both healthcare providers and women would be beneficial. However, domestic violence is often perceived as a "family issue" that is not routinely discussed by healthcare providers. Lack of resources, lack of consultation time and lack of effective referral pathways or support were identified as the main barriers to the provision of quality care.

CONCLUSIONS

Doctors and policy advisors are aware of the problem and open to screening for domestic violence during and after pregnancy. It is suggested that the provision of a speciality trained family liaison officer or healthcare provider would be beneficial. Clear referral pathways need to be established to provide quality care for these vulnerable women in Pakistan.

Screening for antepartum anxiety and depression and their association with domestic violence among Egyptian pregnant women

BACKGROUND

Greater attention has been paid recently to prenatal mental disorders and their association with exposure to domestic violence (DV) as both have serious reproductive consequences.

OBJECTIVES

The aim of this study was to screen for anxiety and/or depression among pregnant women, as well as identify the frequency and association of exposure to DV.

PARTICIPANTS AND METHODS

This cross-sectional study was conducted in 2013 and included a systematic random sample of 376 pregnant women attending the antenatal care outpatient clinic at the largest university hospital in Egypt. Participants were interviewed using a structured questionnaire including three components: sociodemographic characteristics of the participants, the Hospital Anxiety and Depression Scale questionnaire (HADS), and the Hurt, Insulted, Threaten, Scream (HITS) inventory for screening for DV.

RESULTS

Women who expressed simultaneous anxiety and depressive manifestations accounted for 63%, whereas 11.4% and 10.4% of them expressed only anxiety and only depression, respectively. Exposure to DV was detected in 30.6% of all participants, of whom 25.2% were physically hit by their husbands often to most of the time. Simultaneous anxiety and depression was independently associated with lifetime exposure to DV (odds ratio=3.27, 95% confidence interval: 1.28-8.34, P=0.013), whereas having a university-graduated husband was a protective factor from DV (odds ratio=0.22, 95% confidence interval: 0.64-0.75, P=0.01).

CONCLUSION AND RECOMMENDATIONS

Symptoms of anxiety and depression were highly reported among this sample of pregnant Egyptian women and were significantly associated with exposure to intimate partner violence. Screening of pregnant women for mental disorders associated with exposure to DV with provision of supportive mental health services, as well as interventions to reduce exposure to DV, should be considered for integration into antenatal care services.

Ready, willing and able? A survey of clinicians' perceptions about domestic violence screening in a regional hospital emergency department

BACKGROUND

Domestic violence (DV) has significant health impacts for victims and their families. Despite evidence that routine screening increases the identification of DV and opportunities for support; routine screening is uncommon in Australian emergency departments (EDs). This study explored ED clinicians' level of support for DV screening; current screening practices; and perceived barriers and readiness to screen prior to a pilot intervention.

METHODS

Census survey of 76 ED clinicians. A number of questionnaire items were generated through a review of the literature, with readiness to screen for DV assessed through the short version of the Domestic Violence Healthcare Provider Scale [1]. The confidential and anonymous online survey was hosted on the Qualtrics platform. Descriptive and comparative statistical analysis was performed using IBM SPSS version 22.

RESULTS

Most clinicians supported screening for DV in the ED. In the absence of protocols, 72.3% (n=55) of clinicians reported currently engaging in case-based screening, which preferenced women with physical injury. The majority did not always feel comfortable screening for DV (79.7% n=59) and reported they had received insufficient training for this role (88.7% n=55). Lower perceived self-efficacy and fear of offending were statistically associated with discomfort or negative beliefs about DV enquiry (p=<0.05).

CONCLUSION

Emergency department clinicians reported feeling ill-equipped and under-prepared to inquire about and respond to DV. These findings provide valuable insight about the training and support needs of ED clinicians prior to the commencement of routine screening in EDs.

A Scoping Review of Intimate Partner Violence Screening Programs for Health Care Professionals

INTRODUCTION

Between 38 and 59 percent of women presenting to health care professionals have experienced intimate partner violence. Consequently, multiple intimate partner violence identification or screening programs within health care settings have been developed; however, substantial variations in program content and interpretation of program effectiveness has resulted in conflicting practice guidelines. The purpose of our scoping review is to broadly identify and synthesize the available literature evaluating intimate partner violence identification programs within health care settings to identify key areas for potential evidence-based recommendations and to focus research priorities in the field.

MATERIALS AND METHODS

We conducted a search of MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and psycINFO. We used broad eligibility criteria to identify studies that evaluated intimate partner violence identification programs in health care settings. We completed all screening and data extraction independently and in duplicate. We used descriptive statistics to summarize all data.

RESULTS

We identified 59 eligible studies evaluating intimate partner violence identification programs within health care settings. The most commonly reported outcome themes were IPV disclosure (69%, n = 35), number of patients screened (39%, n = 20), HCP opinions towards screening (37%, n = 19), and patient opinions towards screening (29%, n = 15). The majority of studies (36 studies (70.6%)) reported positive program evaluation results.

DISCUSSION

The majority of studies reported positive program evaluation results. This may suggest that many different intimate partner violence identification programs are beneficial for identifying victims of abuse, however, it remains unknown as to whether identification programs prevent future episodes of abuse. Additionally, the substantial heterogeneity of the intervention characteristics, study methodology, and outcome measures assessed limits the ability to make clear recommendations as to the optimal method(s) of screening.

'They just walk away' - women's perception of being silenced by antenatal health workers: a qualitative study on women survivors of domestic violence in Nepal

Background

Domestic violence during pregnancy has detrimental effects on the health of the mother and the newborn. Antenatal care provides a ‘window of opportunity’ to identify and assist victims of domestic violence during pregnancy. Little is known about the experience, needs, and expectations from the women's perspective in relation to domestic violence in Nepal.

Objective

Our study aims to explore how women who have experienced domestic violence evaluate their antenatal care and their expectations and needs from health centers.

Design

Twelve in-depth interviews were conducted among women who had experienced domestic violence during pregnancy and utilized antenatal care. The women were recruited from two different organizations in Nepal.

Results

Women in our study concealed their experience of domestic violence due to fear of being insulted, discriminated, and negative attitudes of the health care providers. The women wished that the health care providers were compassionate and asked them about their experience, ensured confidentiality and privacy, and referred them to services that is free of cost.

Conclusions

Findings from our study may help the health care providers to change their attitudes toward women survivors of domestic violence. Identifying and assisting these women through antenatal care could result in improved services for them and their newborns.

[Care for women victims of violence: empowering nurses in the pursuit of gender equity]

OBJECTIVES

To study the care of women victims of violence provided by nurses in emergency services and to analyse the practices that target the empowerment of women and gender equity.

METHODS

A qualitative, descriptive study conducted by means of interviews with 10 nurses of an emergency and obstetrics unit of a university hospital and local emergency service of a city in southern Brazil from January to April 2013. We used thematic content analysis and defined gender as the analytical category.

RESULTS

Clinical elements refer to nursing procedures and techniques. Non-clinical elements refer to conversation, listening and orientation to the women and their families.

CONCLUSION

Revealing these actions is important to qualify nursing care in relation to the other health professionals and care services for women victims of violence.

Intimate partner violence screening and counseling in the health care setting: Perception of provider-based discussions as a strategic response to IPV

Intimate partner violence (IPV) affects women worldwide, and is addressable in the health care setting not only via screening, but also through provider-based counseling and referral to legal or social services, as appropriate. We conducted a study in Pennsylvania (USA) examining factors associated with receipt of IPV screening and women's perceptions of counseling discussions as a strategic response. We found that women with past-year IPV were more likely to receive screening (aOR: 2.0, 95%CI: 1.2,3.5) and to consider counseling discussions to be a strategic response to IPV exposure (aOR: 2.7, 95%CI: 1.008,7.2) than women with a more distant history of IPV. Scholars and clinicians may learn that, especially for women with a recent history of IPV, screening may provide a conduit to meaningful counseling discussions and referrals that women view as a helpful strategy in responding to IPV.

Creating a Trauma-Sensitive Practice: A Health Care Response to Interpersonal Violence

Interpersonal violence has a profoundly negative impact on individuals and our society. Health care providers are in a unique position to identify interpersonal violence, support survivors, and to contribute to violence prevention. The purpose of this article is to describe the nature, scope, and impact of interpersonal violence, its subsequent trauma on individuals, families, and society, and to delineate how providers can apply trauma-sensitive practice. The authors provide definitions, examples and prevalence rates and review theories of violence and violence prevention. They describe how to create a trauma-sensitive practice by being aware of the trauma that accompanies violence, the barriers to violence prevention, and how to intervene with patients about violence. Providers are urged to adopt universal screening practices, educate themselves on the nature of interpersonal violence and engage in screening, education, collaboration, and social justice activities to reduce interpersonal violence. Resources are provided to assist health care organizations, providers, and patients in addressing interpersonal violence.

Attitudes towards domestic violence in Lebanon: a qualitative study of primary care practitioners

BACKGROUND

Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence.

AIM

To explore physicians' attitudes about responding to DV, their perception of the physician's role, and the factors that influence their response.

DESIGN AND SETTING

Qualitative study using individual interviews among primary care practitioners working in Lebanon.

METHOD

Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role.

RESULTS

Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing the norms of a largely conservative society. Several physicians justified DV or blamed the survivor rather than the perpetrator for triggering the violent behaviour. Moreover, religion was perceived as sanctioning DV.

CONCLUSION

Perceived cultural norms and religious beliefs seem to be major barriers to physicians responding to DV in Lebanon, and possibly in the Arab world more generally. Financial concerns also need to be addressed to encourage physicians to address DV.

Implementing an intimate partner violence (IPV) screening protocol in HIV care

HIV and intimate partner violence (IPV) epidemics propagate and interact in a syndemic fashion contributing to excess burden of disease and poorer health outcomes. In order to understand the impact of IPV on HIV disease management, a universal screening program was implemented in the Southern Alberta Clinic in May 2009. We evaluated our IPV screening protocol and made recommendations for its usage in HIV care. IPV data obtained from patients were evaluated, supplemented with responses from a subset of in-depth interviews. 35% of 1721 patients reported experiencing IPV. Prevalence was higher among females (46%), Aboriginal Canadians (67%), bisexual male/females (48%), and gay males (35%). Of 158 patients interviewed, only 22% had previously been asked about IPV in any health care setting. Patients were responsive to routine IPV screening emphasizing that referral services need to be easily accessible. 23% of patients disclosing IPV subsequently connected to additional IPV resources after screening. We recommend that universal IPV screening be incorporated within regular HIV clinic care. The IPV survey should be given after trust has been established with regular follow-up every 6-12 months. A referral process to local agencies dealing with IPV must be in place for patients disclosing abuses.

Comparing Violence against Women with and Without an Addicted Spouse in Kashan, Iran

BACKGROUND

Although some studies have been conducted on violence against women, but all these studies were conducted in the general population and not the wives of addicts. This study was aimed to compare the violence against women with and without an addicted spouse.

METHODS

This comparative study was conducted on 200 married women in Kashan, Iran. 100 cases were females with addicted spouse and 100 were women with non-addict husbands. Data collected using Haj-Yahia violence questionnaire. Data analysis was performed using SPSS. Descriptive statistics and chi-square, Mann-Whitney U, and Kruskal-Wallis tests, odds ratio (OR) and Kendall's correlation coefficient were used to analyze the data.

FINDINGS

The overall mean score of violence was 69.29 ± 14.84 for the women with addicted husbands and 40.02 ± 9.26 in women with non-addicted spouses (P < 0.001). The mean score of psychological violence was 39.03 ± 7.60 in women with addicted spouses and 21.86 ± 6.11 in those with non-addicted husbands (P < 0.001). Furthermore, the mean score of physical violence was 20.98 ± 6.50 in women with addicted spouses and 12.2 ± 2.55 in those with non-addicted husbands (P < 0.001). Moreover, the mean scores of sexual violence were 4.52 ± 2.21 and 3.28 ± 0.75 in women with and without addicted spouses, respectively (P < 0.001).

CONCLUSION

The overall rate of violence was significantly higher among women with addicted spouse and especially if the spouse abused more than one type of substances. Further investigations are suggested on the effects of opium withdrawal or changes in the substance abused on the rate of violence against women.

The prevalence of violence against Iranian women and its related factors

Background:

Domestic violence against women is a public health problem with negative consequences, and it is an intractable and widespread problem. This type of violence affects the stability of the family.

Aim:

The aim of this study was to estimate the prevalence of any violence against women referring to health centers and explore the associated risk factors with violence in Ahvaz, Iran.

Methods:

A cross-sectional study was conducted on randomly chosen samples of 368 married women aged between 15-55 years in 2013. The samples were divided to two groups, with abused experience and without abused experience. The data were amassed by questionnaire form.

Results:

The prevalence of violence against women was found to be around 63.8%, among them 58.8% were emotional abuse. The majority of women (84%) had never gone to a counseling center. Findings show 47% of women were silent, 27% got in a fight, 7% screamed, 6% abused their children, and 5% threw things when occurred violence against them. Experience of violence in women correlated with the marriage age of woman, numbers of children, and difference of marriage age between couple, marriage age of men, employed women, uneducated women and the rate of drugs use in their husbands.

Conclusions:

Nurses and other health care providers can and should play a major role in empowering women living with violence and promote education, social policies and attitudes that proactively prevent violence.

Israeli Arab Muslim women's willingness to be screened for intimate partner violence: A survey

In the present study, we explored whether the research model based on the Theory of Reasoned Action predicts Israeli Arab Muslim women's willingness to be screened for intimate partner violence at healthcare facilities. Three hundred women completed a questionnaire. Most women (68.4%) expressed willingness to be screened, however, only 16% of them had been screened over the past year. Women's beliefs about screening for intimate partner violence and the support of significant others were found to predict this willingness. The study may constitute an initial foundation for determining national policy with the aim of detecting and eradicating the phenomenon among this unique population.

Addressing domestic violence in primary care: what the physician needs to know

Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge on adequately managing cases of DV and on appropriate ways to help survivors is commonly presented as a barrier. This article presents the magnitude of the problem of DV in the Arab world, highlights the role of the primary care physician in addressing this problem, and provides practical steps that can guide the clinician in the Arab world in giving a comprehensive and culturally sensitive service to the survivors of DV.

Intimate partner violence: a guide for primary care providers

Women, men, children, and adolescents who self-disclose exposures to or at risk for exposures to intimate partner violence or domestic violence may exhibit moderate-to-severe psycho-social-emotional, mental, and physical healthcare problems. Healthcare providers have a unique opportunity to assist this population in the primary care office.